<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title><?php echo $title ?></title>
<?php echo $jscript?>
<?php echo $jscript_add?>
<?php echo $css?>
<?php echo $css_add?>
<script type="text/javascript">
function setfocus(){
	$('username').focus();
}
window.addEvent('domready',function(){
   // setfocus();
		
        new FormCheck('formsignup',{
			display : {
			errorsLocation : 1,
			showErrors : 1,
			addClassErrorToField : 1
		}
	})
});
</script>

</head>

<body>
<div class="margin-top-100" align="center">
<table width="0" border="0" align="center" cellspacing="0" cellpadding="0">
  <tr>
    <td valign="middle" class="capitalize font-size-24 font-color-default">Sign Up<span class="italic bold font-size-40">!</span></td>
  </tr>
  <tbody></tbody>
</table><br />
<table width="70%" border="0" cellspacing="0" cellpadding="0" class="table-box bg-trans">
  <tr>
    <td>
    
<form action="<?php echo base_url()?>signup/regstudent" method="post" enctype="multipart/form-data" name="formsignup" class="font-size-14 capitalize" id="formsignup">
  	  
  
  <table width="100%" border="0" cellspacing="2" cellpadding="3">
    <tr>
      <td width="50%" valign="top">
      <div class="margin-top-20 margin-bottom-10 padding-left-30 font-size-18 font-color-gray">
      About You
      <hr size="1" color="#CCCCCC" width="100%" align="left" />
      </div>
      <table width="100%" border="0" cellspacing="2" cellpadding="3">
        <tr>
          <td width="130" align="right" valign="middle">Name</td>
          <td><input name="first_name" type="text" class="text-default validate['required']" id="first_name" size="18" placeholder="first name" />
            <input name="last_name" type="text" class="text-default" id="last_name" size="20" placeholder="last name" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">Born Place</td>
          <td><input type="text" name="born_place" id="born_place" class="text-default validate['required']" placeholder="the place where you born" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">Birthday</td>
          <td><input name="birthday" type="text" class="text-default validate['required']" id="birthday" size="12"  placeholder="yyyy-mm-dd" /></td>
        </tr>
      </table>
      
      <div class="margin-top-30 margin-bottom-10 padding-left-30 font-size-18 font-color-gray">
      Username
      <hr size="1" color="#CCCCCC" width="100%" align="left" />
      </div>
        <table width="100%" border="0" cellspacing="2" cellpadding="3">
        <tr>
          <td width="130" align="right" valign="middle">username</td>
          <td><input name="username" type="text" class="text-default validate['required']" id="username" maxlength="25" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">password</td>
          <td><input name="password" type="password" class="text-default validate['required']" id="password" maxlength="25" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">confirm password</td>
          <td><input name="confirm" type="password" class="text-default validate['confirm[password]']" id="confirm" maxlength="25"/></td>
        </tr>
        <tr>
          <td align="right" valign="middle">image</td>
          <td><input type="file" name="images" id="images" /><div class="font-color-gray italic font-size-10 untransform">jpeg, png, bmp</div></td>
        </tr>
      </table></td>
      <td valign="top">
      <div class="margin-top-20 margin-bottom-10 padding-left-30 font-size-18 font-color-gray">
      Contact
        <hr size="1" color="#CCCCCC" width="96%" align="left" />
      </div>
      <table width="100%" border="0" cellspacing="2" cellpadding="3">
        <tr>
          <td width="120" align="right" valign="middle">adddress</td>
          <td><input name="address" type="text" class="text-default validate['required']" id="address" size="35" placeholder="where do you live" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">email</td>
          <td><input name="email" type="text" class="text-default validate['required','email']" id="email" size="30" placeholder="your email" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">phone</td>
          <td><input name="phone" type="text" class="text-default validate['phone']" id="phone" size="18" placeholder="" /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">facebook</td>
          <td><input name="facebook" type="text" class="text-default" id="facebook" size="27" placeholder="ex: facebook.com/..." /></td>
        </tr>
        <tr>
          <td align="right" valign="middle">twitter</td>
          <td><input name="twitter" type="text" class="text-default" id="twitter" size="23" placeholder="ex: @infosmenda" /></td>
        </tr>
      </table>
      <div class="margin-top-20 margin-bottom-10 padding-left-30 font-size-18 font-color-gray">
      Student Identity
        <hr size="1" color="#CCCCCC" width="96%" align="left" />
      </div>
      <table width="100%" border="0" cellspacing="2" cellpadding="3">
        <tr>
          <td width="120" align="right" valign="middle">year</td>
          <td><select name="year" id="year" class="select-default">
          <option value=""></option>
          <?php
          $now = date("Y");
          $ago = ($now-3);
          for($a = $now; $a>$ago; $a--){
          	echo "<option value='".$a."'>$a</option>";
          }
		  ?>
          
          </select>
          <span class="font-size-10 font-color-gray italic">first check in</span>
          </td>
        </tr>
        <tr>
          <td align="right" valign="middle">faculty</td>
          <td><select name="faculty" id="faculty" class="select-default">
            <option value=""></option>
            <option value="RPL">RPL</option>
            <option value="MM">MM</option>
            <option value="AK">AK</option>
            <option value="APK">APK</option>
            <option value="PMS">PMS</option>
            <option value="PBK">PBK</option>
          </select></td>
        </tr>
        <tr>
          <td align="right" valign="middle">class</td>
          <td>
          <select name="class" id="class" class="select-default">
            <option value=""></option>
            <option value="1">1</option>
            <option value="2">2</option>
            <option value="3">3</option>
          </select>
          </td>
        </tr>
      </table>
      </td>
    </tr>
    <tr>
      <td colspan="2" align="right" valign="top">
      <input type="reset" name="button2" id="button2" value="Reset" />
      <input type="submit" name="button" id="button" value="Sign-Up" /></td>
      </tr>
  </table>
</form>
    
    </td>
  </tr>
</table>
<br />
</div>
</body>
</html>